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Objective To assess the value of percutaneous posterior ultrasound-guided transgluteal approach for draining presacral abscesses.Methods From June 2013 to December 2015,retrospectively reviewed were performed in 48 patients with presacral abscesses confirmed by CT or magnetic resonance imaging(MRI)were retrospectively reviewed,and these patients underwent percutaneous US-guided transgluteal abscess drainage and catheter placement.The medical records were reviewed to determine the origins,location,and size of the abscesses,size of catheter,duration of catheter drainage,incidence of catheter-related pain and procedure-related complications,and short and long-term outcomes.The duration of drainage among different size of drainage catheter was compared,and the correlation between the volume of abcess and duration of abcess drainage was analyzed.Results The origins of the pelvic abscesses included anastomotic leakage after colorectal cancer surgery(n=38)and congenital macrocolon operation(n=3),radiation proctitis(n=2),recurrence of rectal cancer complicated with intestinal perforation,Crohn disease(n=1),appendicitis with abscess formation(n=1),rectal fistula(n=1),and postoperative pancreatic pseudocyst(n=1).The abscesses were 24-135 mm in diameter.The volume of the abscesses was 4.8-283.4 ml.The sizes of catheters used were 8-12F,and the mean duration of drainage was 13 days(range:1-52).In 42(91.3%)of 46 patients,there was complete resolution of the abscess following transgluteal drainage,without subsequent surgery.In four of 46(8.7%)patients,incomplete resolution necessitated subsequent surgery.No significant difference in drainage time was observed among 8-16F catheters(all P ＞ 0.05).The volume of abscess was positively correlated with the drainage time(r=0.281,P＜0.05).No major complications were observed,either during or after the transgluteal procedure.Conclusion Percutaneous US-guided transgluteal drainage is a safe,effective and well tolerated alternative to surgery for deep pelvic abscesses,and thus is worthy of clinical application.
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Objective To investigate the value of endorectal ultrasonography (ERUS) inpreoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy.Methods From Jan.2016 to Dec.2016,90 rectal cancer patients who underwent preoperative neoadjuvant chemoradiation therapy and total mesorectal excision surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed,and all patients underwent ERUS examination post neoadjuvant chemoradiation therapy.Of these,64 patients were evaluated by ERUS pre and post neoadjuvant chemoradiation therapy and 26 patients were evaluated only post neoadjuvant chemoradiation therapy.Wilcoxon rank sum test for paired sample was performed to compare the distance from inferior margin of tumor to anal margin,the length and thickness of the tumor pre and post neoadjuvant chemoradiation therapy respectively in rectal cancer.Taken pathologic findings as golden standard,the accuracy of T staging assessed by ERUS post neoadjuvant chemoradiation therapy was evaluated.Results Compared with pre neoadjuvant chemoradiation therapy,the distance from inferior margin of tumor to anal margin significantly increased after neoadjuvant chemoradiation therapy [(58.63±21.71) mm vs (51.68± 19.81) mm],and the length [(26.10± 10.07) mm vs (40.82±9.18) mm] and thickness [(9.73±2.50) mm vs (14.92±5.30) mm] of tumor also evidently decreased post neoadjuvant chemoradiation therapy,respectively (Z were 4.996,6.153 and 6.076,all P ＜ 0.01).The final pathological T stage was pathologic complete response (pCR) or pT0 in 15 patients,pT1 in 3 patients,pT2 in 30 patients and pT3 in 42 patients.The diagnostic accuracy of T staging of rectal cancer post neoadjuvant chemoradiation therapy for ERUS was uT0 82.2％ (74/90),uT1 96.7％ (87/90),uT2 66.7％ (60/90),uT3 67.8％ (61/90) and uT4 96.7％ (87/90),and the overall accuracy was 82.2％ (74/90).Conclusion ERUS could effectively record the morphological changes of rectal cancer pre and post neoadjuvant chemoradiation therapy,which may contribute to the re-evaluation of the distance from inferior tumor margin to anal margin and the range and depth of tumor involvement pre surgical resection.
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Objective To evaluate the value of endorectal ultrasonography (ERUS) in assessment of mesorectal fascia (MRF) invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn't acceped.Taking the pathological diagnosis of circumferential resection margin (CRM) as the gold standard,the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.Results The final pathological T staging was T1 in 2 cases,T2 in 17 cases and T3 in 25 cases.There were 2 cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5 cases with a circle of rectum.The diagnostic accuracy were 83.33 ％ (15/18) and 92.31％ (24/26) for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77％ (21/26) for cases located in anterior or antero-lateral wall,and 100％ (13/13) for cases located in posterior or postero-lateral wall;75.00％ (12/16)and 96.43 ％ (27/28) for low position and mid position tumors.The total diagnostic accuracy was 88.64％ (39/44).Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.
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ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.
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Objective To investigate the effects of remifentanil on lung ischemia-reperfusion (I/R) injury and expression of angiotensin-converting enzyme (ACE) mRNA in rats.Methods Forty pathogen-free adult male Sprague-Dawley rats,weighing 300-350 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S),group I/R and different doses of remifentanil groups (groups R1-R3).Lung I/R was produced by occlusion of the left hilum of lung for 45 min followed by 120 min reperfusion.Remifentanil was infused intravenously at a rate of 0.2,0.6 and 1.2 μg·kg-1 ·min-1 until 120 min of reperfusion after a loading dose of 1 μg/kg at 15 min before occlusion of the left hilum of lung in groups R1,R2 and R3,respectively.The equal volume of normal saline was given in groups S and I/R.The rats were scarified at 120 min of reperfusion and lungs were removed for microscopic examination and determination of wet/dry lung weight ratio (W/D ratio) and the expression of ACE mRNA (by RT-PCR) in the lung tissue.The pathological changes of the lung were scored.Results Compared with group S,the pathological score and W/D ratio were significantly increased and the expression of ACE mRNA was up-regulated in groups I/R,R1 and R2,and the pathological score was significantly increased (P ＜ 0.05),and no significant change was found in W/D ratio and the expression of ACE mRNA in group R3 (P ＞ 0.05).Compared with group I/R,the pathological score and W/D ratio were significantly decreased and the expression of ACE mRNA was down-regulated in groups R2 and R3,and the pathological score and W/D ratio were significantly decreased (P ＜ 0.05) and no significant change was found in the expression of ACE mRNA in group R1 (P ＞0.05).Compared with group R1,the pathological score and W/D ratio were significantly decreased and the expression of ACE mRNA was down-regulated in group R3,and the pathological score and W/D ratio were significantly decreased (P ＜ 0.05) and no significant change was found in the expression of ACE mRNA in group R2 (P ＞ 0.05).The pathological score,W/D ratio and expression of ACE mRNA were significantly lower in groups R3 than in group R2 (P ＜ 0.05).The pathological changes of the lung were significantly reduced in groups R1-R3 as compared with group I/R.Conclusion Remifentanil can attenuate lung I/R injury in rats in a dose-dependent manner and down-regulation of ACE mRNA expression may be involved in the mechanism.
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Objective To investigate the effects of remifentanil on sinoatrial (SA) node autorhythmicity in rabbits.Methods Twenty-four healthy rabbits of both sexes weighing 1.8-2.2 kg were sacrificed.Their hearts were removed and sinoatrial nodes were dissected and placed in Tyrode solution saturated with 95 ％ O2-5 ％ CO2 at 36 ℃.The action potentials of the sinus node pacemaker cells were recorded by intracellular glass microelectrode technique.The experiment was performed in 3 parts (n =8 each).Part Ⅰ:the sinoatrial node was exposed to remifentanil 2,4,8,16 and 32 ng/ml respectively.The action potentials were recorded after the sinoatrial nodes were exposed to each concentration of remifentanil for 15 min.Part Ⅱ and Ⅲ:the sinoatrial nodes were first exposed to Ca2+ channel agonist Bay K8644 0.5 μmol/L or K+ channel blocker TEA 20 nmol/L for 15 min.Then remifentanil was added until the concentration reached 16 ng/ml (final concentration) and 15 min later the action potentials were recorded.The action potential parameters included,amplitude of action potential (APA),rate of pacemaker firing (RPF),action potential duration at 90％ repolarization (APD90) and velocity of diastolic depolarization (VDD).Results Remifentanil significantly decreased,APA,RPF,VDD and prolonged APD90 in a concentration dependent manner as compared with the baseline values.Pretreatment with Bay K8644 could block the effects of remifentanil on SA node pacemaker cells,while TEA did not affect the electrophysiologic effects of remifentanil on SA node pacemaker cells.Conclusion Remifentanil exerts a negative chronotropic action on SA node pacemaker cells.These effects are likely produced by decrease in Ca2+ current,while opening of K + channels is not involved in these effects.